Adaptação transcultural para o idioma português do método de triagem nutricional Determine your nutritional health (R) para idosos domiciliados / Cross-cultural adaptation to the Portuguese language of the Determine Your Nutritional Health (R) screening method for the elderly in assisted living accommodation

ABSTRACT IN PORTUGESE: O objetivo deste artigo é descrever o processo de adaptação transcultural do método de triagem nutricional, Determine Your Nutritional Health® (DNH), para utilização na população idosa brasileira. O DNH consiste de 10 questões com enunciados afirmativos, às quais são atribuídas pontuações específicas e cuja soma corresponde ao escore final, que classifica os indivíduos de acordo com a presença ou a ausência de risco nutricional. O processo de adaptação transcultural do método DNH envolveu as seguintes etapas: tradução; retrotradução; equivalência semântica; avaliação dos especialistas; pré-teste e versão final do método. Foram realizadas adaptações de palavras e expressões do método DNH, para a realidade brasileira. A versão final do método foi definida para o Brasil como “Verifique a condição nutricional do idoso”, apresentando as mesmas questões da versão original do DNH, contudo, em formato mais claro, por meio de perguntas, consideradas acessíveis e de fácil entendimento, segundo a avaliação de profissionais de saúde e de idosos. A versão brasileira do método de triagem nutricional, “Verifique a condição nutricional do idoso”, encontra-se traduzida e adaptada para uso em idosos brasileiros domiciliados. ABSTRACT IN ENGLISH: This article aims to describe the process of cross-cultural adaptation of the Determine Your Nutritional Health® (DNH) screening method for the elderly Brazilian population. The DNH consists of 10 questions with affirmative statements, to which specific scores are assigned and when added up correspond to the final score, which classifies individuals according to the presence or absence of nutritional risk. The process of cross-cultural adaptation of the DNH method involved the following stages: translation; back translation; semantic equivalence; evaluation by the experts; pre-test and final version of the method. Adjustments were made in words and expressions of the DNH method for the Brazilian reality. The final version of the method has been defined for Brazil as “Verify the nutritional conditions of the elderly,” presenting the same questions as in the original version of the DNH. It was in a clearer format, through questions, considered accessible and easy to understand, according to the assessment of health professionals and the elderly. The Brazilian version of the nutritional screening method, “Verify nutritional conditions of the elderly,” was translated and adapted, for use in Brazilian elderly in assisted living accommodation

Minimally processed fruit salad enriched with Lactobacillus acidophilus: Viability of anti-browning compounds in the preservation of color

Minimal processing promotes browning of some vegetal tissues due to cell membrane disruption, which results in the release of oxidative enzymes. This study evaluated the efficiency of citric acid, ascorbic acid, sodium metabisulfite and L-cysteine hydrochloride to retard enzymatic browning of minimally processed fruit salad and enriched this product with Lactobacillus acidophilus LA-5. Control treatment was fruit salad immersed in water. Polyphenol oxidase (PPO) and color (L*, a*, b*, index color - CI, browning index - BI, c*, and h°) were analyzed. The viability of L. acidophilus was also evaluated using Rogosa agar in fruit salads containing anti-browning compounds in higher concentrations. PPO presented a significant difference among control and fruit salad treated with ascorbic acid and L-cysteine hydrochloride, indicating the highest anti-browning activity of these compounds. The fruit color was affected by processing and storage time, with a reduction in the values of L* over time. Values of a*, c*, h° angle and CI indicated a predominance of red color in the fruit salad. Salads containing anti-browning compounds in higher concentrations presented viability of L. acidophilus above 7.43 log CFU/g up to the fifth day of storage, indicating that the product can be promised as probiotic. Thus, the fruit salad treated with anti-browning compounds has potential use as a probiotic carrier.Keywords: Fresh-cut fruits, color, ascorbic acid, vegetable matrix, probiotic culture

Is slowness a better discriminator of disability than frailty in older adults?

Background:The trajectory of incident disability that occurs simultaneously with changes in frailty status, as well as how much each frailty component contributes to this process in the different sexes, are unknown. The objective of this study is to analyse the trajectory of the incidence of disability on basic and instrumental activities of daily living (BADL and IADL) as a function of the frailty changes and their components by sex over time. // Methods: Longitudinal analyses of 1522 and 1548 of the English Longitudinal Study of Ageing study participants without BADL and IADL disability, respectively, and without frailty at baseline. BADL and IADL were assessed using the Katz and Lawton Scales and frailty by phenotype at 4, 8, and 12 years of follow-up. Generalized mixed linear models were calculated for the incidence of BADL and IADL disability, as an outcome, using changes in the state of frailty and its components, as the exposure, by sex in models fully adjusted for sociodemographic, behavioural, biochemical, and clinical characteristics. // Results: The mean age, at baseline, of the 1522 eligible individuals free of BADL and free of frailty was 68.1 ± 6.2 years (52.1% women) and of the 1548 individuals free IADL and free frailty was 68.1 ± 6.1 years (50.6% women). Women who became pre-frail had a higher risk of incidence of disability for BADL and IADL when compared with those who remained non-frail (P < 0.05). Men and women who became frail had a higher risk of incidence of disability regarding BADL and IADL when compared with those who remained non-frail (P < 0.05). Slowness was the only component capable of discriminating the incidence of disability regarding BADL and IADL when compared with those who remained without slowness (P < 0.05). Weakness and low physical activity level in men and exhaustion in women also discriminated the incidence of disability (P < 0.05). // Conclusions: Slowness is the main warning sign of functional decline in older adults. As its evaluation is easy, fast, and accessible, screening for this frailty component should be prioritized in different clinical contexts so that rehabilitation strategies can be developed to avoid the onset of disability

Toxicological evaluation of lactose and chitosan delivered by inhalation

These days, inhalation constitutes a promising administration route for many drugs. However, this route exhibits unique limitations, and formulations aimed at pulmonary delivery should include as few as possible additives in order to maintain lung functionality. The purpose of this work was to investigate the safety of lactose and chitosan to the pulmonary tissue when delivered by inhalation. The study was carried out with 18 Wistar rats divided in three groups receiving distilled water, lactose or chitosan. A solution of each excipient was administered by inhalation at a dose of 20 mg. The lungs were excised and processed to determine several biochemical parameters used as toxicity biomarkers. Protein and carbonyl group content, lipid peroxidation, reduced and oxidized glutathione ( GSSG), myeloperoxidase ( MPO), cooper/zinc and manganese superoxide dismutase, catalase, glutathione S-transferase and glutathione peroxidase were determined. Results of myeloperoxidase activity and glutathione disulfide lung concentrations showed a relevant decrease for chitosan group compared to control: 4.67 +/- 2.27 versus 15.10 +/- 7.27 ( P = 0.011) for MPO and 0.89 +/- 0.68 versus 2.02 +/- 0.22 ( P = 0.014) for GSSG. The other parameters did not vary significantly among groups. Lactose and chitosan administered by inhalation failed to show toxic effects to the pulmonary tissue. A protective effect against oxidative stress might even be attributed to chitosan, since some biomarkers had values significantly lower than those observed in the control group when this product was inhaled. Nevertheless, caution must be taken regarding chemical composition and technological processes applied to incorporate these products during drug formulation, in particular for dry powder inhalators

How the 'plates' of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil's Sao Paulo and Maranhao states

Background: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. Methods: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. Results: We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible–if insecure–working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. Conclusions: The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded

The costs of preventing and treating chagas disease in Colombia

Background: The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy. Methods: Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation. Findings: The mean cost per house per entomological survey was $4.4 (in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between$46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is$1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care. Conclusion: Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.Wellcome Trus

DMSO removal reduces stem-cell infusion-related toxicity and allows excellent engraftment of cryopreserved unrelated cord blood and autologous stem cells

UNIFESP, GRAACC, Pediat Oncol Inst, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUNIFESP, GRAACC, Pediat Oncol Inst, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Background Offloading interventions are commonly used in clinical practice to heal foot ulcers. The aim of this updated systematic review is to investigate the effectiveness of offloading interventions to heal diabetic foot ulcers. Methods We updated our previous systematic review search of PubMed, EMBASE, and Cochrane databases to also include original studies published between July 29, 2014 and August 13, 2018 relating to four offloading intervention categories in populations with diabetic foot ulcers: (a) offloading devices, (b) footwear, (c) other offloading techniques, and (d) surgical offloading techniques. Outcomes included ulcer healing, plantar pressure, ambulatory activity, adherence, adverse events, patient‐reported measures, and cost‐effectiveness. Included controlled studies were assessed for methodological quality and had key data extracted into evidence and risk of bias tables. Included non‐controlled studies were summarised on a narrative basis. Results We identified 41 studies from our updated search for a total of 165 included studies. Six included studies were meta‐analyses, 26 randomised controlled trials (RCTs), 13 other controlled studies, and 120 non‐controlled studies. Five meta‐analyses and 12 RCTs provided high‐quality evidence for non‐removable knee‐high offloading devices being more effective than removable offloading devices and therapeutic footwear for healing plantar forefoot and midfoot ulcers. Total contact casts (TCCs) and non‐removable knee‐high walkers were shown to be equally effective. Moderate‐quality evidence exists for removable knee‐high and ankle‐high offloading devices being equally effective in healing, but knee‐high devices have a larger effect on reducing plantar pressure and ambulatory activity. Low‐quality evidence exists for the use of felted foam and surgical offloading to promote healing of plantar forefoot and midfoot ulcers. Very limited evidence exists for the efficacy of any offloading intervention for healing plantar heel ulcers, non‐plantar ulcers, and neuropathic ulcers with infection or ischemia. Conclusion Strong evidence supports the use of non‐removable knee‐high offloading devices (either TCC or non‐removable walker) as the first‐choice offloading intervention for healing plantar neuropathic forefoot and midfoot ulcers. Removable offloading devices, either knee‐high or ankle‐high, are preferred as second choice over other offloading interventions. The evidence bases to support any other offloading intervention is still weak and more high‐quality controlled studies are needed in these areas